The Specific Aim of this R03 is to conduct secondary analyses of data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, which was conducted from 1998-2001. The study was a clinical trial funded by the National Institute of Aging (NIA) and National Institute on Nursing Research (NINR) and conducted at six field sites with a data-coordinating center. The primary objective of ACTIVE was to test the effectiveness and durability of three distinct cognitive interventions in improving older adults' performance on basic measures of cognition and on measures of cognitively demanding daily activities (reported in JAMA, 2002). The ultimate goal of this initiative was to reduce the public health problems related to loss of independence in the elderly, specifically the need for formal health care services. The Primary Aim of this proposal is to evaluate the effectiveness of the ACTIVE cognitive interventions in reducing demand for and use of formal health care services. The Specific Aims of the proposed project are to analyze data to: 1) investigate the effect of cognitive training on participants' health-related quality of life; 2) evaluate the relationship of intervention group assignment and formal health care services utilization; 3) evaluate the mediating role of proximal intervention effectiveness (degree of improvement in trained cognitive abilities) and distal health services use outcomes; and 4) assess the validity of self-reported health services utilization by comparing self-reported use of (Medicare reimbursable) services to Medicare claims data. ACTIVE is one of the largest purely behavioral treatment trials. Because of its size and the carefully developed rigor, its datasets offer to investigators a wealth of opportunities for secondary analyses. Funding for the ACTIVE trial ended on 12/31/02. Funds are being requested to support the work of the study investigators to analyze secondary outcomes not previously investigated due to insufficiency of funds in the initial award. The trial data currently are being archived for public use and are available only to the ACTIVE investigators.